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WC- VANDALIA OPS LLC NPI 1053709303


NPI Information

NPI: 1053709303
Provider Name: WC- VANDALIA OPS, LLC

Doing Business As: BROOKSTONE ESTATES OF VANDALIA

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 14D2209406

Address:
1607 W FILLMORE ST
VANDALIA, IL
ZIP 62471
Phone: (618) 283-9825
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WC- VANDALIA OPS, LLC is an assisted living facility in Vandalia, IL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. WC- VANDALIA OPS, LLC NPI is 1053709303. The provider is registered as an organization entity type.
The provider Is Doing Business As Brookstone Estates Of Vandalia.

The provider's business location address is:

1607 W FILLMORE ST
VANDALIA, IL
ZIP 62471-112
Phone: (618) 283-9825
Fax: (618) 283-9926

The provider's authorized official is Shelly Dothager .
The authorized official title is Executive Director and has the following contact phone number (618) 283-9825.

The CLIA number assigned to this NPI record is 14D2209406 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/8/2015 and was last updated on 1/8/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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